ADHD and Your Child: ADHD Experts Address Your Questions

"ADHD and Your Child" webinarFollowing our free “ADHD and Your Child” webinar last spring, we received a number of questions from parents and teachers alike on understanding and supporting persons with ADHD. For National ADHD Awareness Month, we wanted to revisit a number of these questions and invite you to watch the archived webinar with ADHD experts Doug Bouman, S. Psy. S. and Robert Bulten, M.D. This webinar, hosted by Christian Schools International, covers the symptoms and treatments of ADD/ADHD.

Q: Is ADHD hereditary?

Dr. Bulten: Very much so. It the second most heritable condition in the human genome.  The first is height.

Q: Are there similarities between teenage boys and ADHD?  When should we seek testing and treatment for ADHD?

Dr. Bulten: It used to be thought that ADHD in boys far outnumbered that in girls. But we’ve now realized that this is no longer true, and ADHD is common in both boys and girls. During the teen years, the hyperactive component (which is so common in younger boys) tends to become less noticeable. Testing and treatment should be looked into when the symptoms become a functional impairment.

Q: How much does a child’s diet help or hinder a child with ADHD?

Dr. Bulten: Diet does not usually have much positive or negative effect on a child with ADHD. Now and then, someone will find a particular food (e.g. dairy, gluten, dyes, etc.) that they believe helps to a degree, and then they take that out of the diet. But the return is so small that I don’t recommend that to start treatment. By the time my patients get to me, they will have tried all the non-medical options.

Young Boy PhotoQ: What are some particular gifts kids or teens with ADHD possess?

Mr. Bouman: ADHD in and of itself provides zero benefits to the student with ADHD.  For example, the gift of creativity or artistic ability and ADHD are not linked. However, just like students without ADHD, students with ADHD possess incredible gifts, strengths, and abilities.

Q: Are students with ADD/ADHD more likely highly intelligent and gifted than not?

Mr. Bouman: Students with ADHD are not more gifted and talented than those without ADHD.  ADHD impacts the entire range of abilities.  In fact, highly intelligent children with ADHD frequently experience more frustration since they are painfully aware that their performance and output is markedly below their intellectual abilities and peer performance.  How frustrating and painful for a bright student to “know” what to do, yet are unable “to do what they know”.

Q: Do you see the emotional issues, such as loss of confidence and “self prosecution” (especially in newly diagnosed teenagers) improve over time?

Mr. Bouman: Yes, for sure.  The first step is for the teenager and the significant adults (parents, school staff, etc.) to understand and accept ADHD, and how it is impacting this student’s daily functioning.  Once effective strategies and medication are in place, the student experiences authentic success (i.e. they can now “do and produce what they know”).  This frequently buoys their confidence and eliminates their self-persecution.

Q:  What is one thing you wish parents knew about ADHD?

Mr. Bouman: There is a tremendous amount of misinformation in the media, trade magazines, etc.  Parents need to know ADHD hugely impacts a student’s learning and productivity in school even though their child is not hyperactive or impulsive.  Quiet, hidden (inattentive type) ADHD is more dangerous since it is easily missed or misinterpreted as not trying or a bad attitude.  Complicating things is the remarkable inconsistency observed in a student with ADHD, sometimes called a “picket fence” up-down functioning.  Children, adolescents and adults with ADHD are frequently able to focus and sustain concentration if what they are doing is preferred, highly stimulating, high interest (think video games, legos, T.V., even reading high interest books).  The real test of an individual’s attention is when they must complete tasks that are important yet boring.  Another important parent “tip”, is to watch for limited improvement (e.g. learning, producing, grades, behavior) when individuals, student, teachers, and school support staff have honestly tried their best to overcome the problem using methods that work for most kids.

Dr. Bulten: Probably that they are not the cause of their kid’s ADHD – unless you consider the genetics. It’s not bad parenting–more discipline will not change things—it will probably make things worse.

Students learningQ: What is one thing you wish teachers knew about ADHD?

Mr. Bouman:
(1) All of what I wish parents knew (see above)

(2) Please be careful to simply and thoroughly report to parents what you notice in class and avoid saying a student has or does not have ADHD.

Dr. Bulten: Again, that they are not the cause of the student’s ADHD. “Carrot and stick” discipline will not change anything.

Q: What are a few practical strategies a teacher can use in the classroom to support a student with ADHD?

Mr. Bouman: Move the student close to the teacher. Having the student in close physical proximity to the teacher affords closer monitoring of the student and increased accountability.  Teachers can cue the student that important directions are coming their way (e.g. “students the next two instructions are really important” – sometimes referred to as “verbal highlighting”).  Close proximity also allows ongoing accountability with high frequency feedback (e.g. “do this first row of math computations and then check back with me”).

Students with ADHD need understanding and empathy from their teacher; their teacher needs to recognize that they are fighting upstream against a roadblock that their peers are not.  Teachers can create a “prosthetic classroom” by externalizing (making visible and permanent) instructions, requirements, rules, and steps (e.g. use of post-it-notes, lists, pictures).

Q: What is one thing you wish kids/teens knew about ADHD?

Mr. Bouman: Kids really like the truth about how ADHD is negatively impacting the use of their gifts.  Many students have conjured up something far worse (e.g. “I’m stupid”, “I’m dumb”) than ADHD.  Kids need to understand ADHD is not their fault any more than it is their fault for having brown eyes. Kids need to know there are effective interventions that can ‘even the playing field’ for them. They need to know that things will get better and there is great hope for the future.

Dr. Bulten: I wish kids with ADHD knew they were not lazy. As I interview adults with ADHD and ask them what one comment they remember their parents and teachers said was, “If you would only try harder. You have so much potential and you just don’t apply yourself.” If we could measure “effort”, especially in young kids, we’d find they are trying harder than other kids and the results are poorer. As they get older, they start to give up and they stop trying altogether.

Q: What are some practical strategies persons with ADHD can use to accomplish tasks in their daily life?

Mr. Bouman: First, make sure any prescribed medication is at optimal levels.  Students and adults with ADHD are ideally completing a one or two page symptom reduction form each time they meet with their physician.  Other strategies include:

(1) Writing down your top three non-negotiables for taking good care of yourself.

(2) Enlisting accountability supports – a trusted friend or life coach.

(3) Use technology as a work-around.

Q: Do you have any recommended books or websites to learn more about ADHD?

Mr. Bouman: The best organization with incredible resources is CHADD – Children and Adults with Attention Deficit/Hyeractivity Disorder.

The best book for adults is Reaching for a New Potential: A Life Guide for Adults with ADD From a Fellow Traveler by Oren Mason.  Also check out Dr. Mason’s blog, Attentionality.

At CLC Network, we daily evaluate and create plans for struggling students based on their strengths and areas of need. Learn more about our perspective in this video and visit our website to learn more.

And of course, Dr. Bulten at Behavioral Medicine Clinic does an incredible job monitoring and supporting patients.

 Doug Bouman photoDoug Bouman, S. Psy. S. is the director of evaluation services at CLC Network (Christian Learning Center) in Grand Rapids, MI, a Nationally Certified School Psychologist and a Licensed Master’s Social Worker. He is a graduate of Calvin College and Central Michigan University.

 

 

Dr. Bulten photoRobert Bulten, M.D. previously practiced general pediatrics for 12 years and has been practicing behavioral medicine (including ADHD, Autism Spectrum Disorder, and mood disorders) for the past 30 years. He is a graduate of Wheaton College and the University of Michigan Medical School.

“Time Out” for Empathetic Development

I know a few grown-ups who, when confronted about their hurtful behavior, offer this as their apology.  “I’m sorry that you misunderstood what I said (or did)”.  Hmm…I have always wondered why they believe their inability to take personal responsibility for their actions along with their lack of empathy is a real apology.

Grumpy boyDuring my graduate years in college, I worked at a residential treatment center for adolescent boys and girls that used a very rigid behavioral approach to therapy.  There was a complex token economy and level system and very clear guidelines for when and how to use the behavioral strategy of “time out”.

I remember clearly a 12 year old boy named David who had severe anger and who frequently exploded with both physical and verbal outbursts.  After an outburst he would be given the required and necessary “time out” period.  Upon completion, I would ask him if he was sorry.  He would always answer that he was (but under his breath he would add the phrase, “sorry I got caught”).

David’s version of the “Golden Rule” was similar to that of many of the other residents: “Do unto others before they do unto you.”  That was the “ah ha” moment for me.

Psychologists Jean Piaget and Lawrence Kohlberg have provided us with some of the building blocks necessary for understanding that there are clear stages for acquiring empathy and moral development.  Social psychologists believe that although children are born with a capacity for empathy, they must learn to become empathetic.

How can we help children learn to become empathetic? 

Using “time out” followed by developmentally appropriate processing can be very effective.  Before allowing our students and children to re-enter an activity from a “time out”, ask the following questions:

  • Why did I ask you to take a “time out”?
  • What did you think was happening?
  • How do you think you would feel if it happened to you?
  • How would you want that person to respond to you? (Ah ha…the golden rule!)
  • What will you do differently next time?

Saying “I’m sorry” is more than just a formality

As our children grow, we need to model and directly teach them how to apologize. Children in the early stages of social and moral development have not yet internalized the value of seeking and wanting forgiveness.  That of course, requires having empathy and an understanding of “doing unto others as you would have them do unto you”.  Therefore, such values eventually have to become seamlessly spontaneous and sincere.

For example, Erin’s teacher tells her:

“Tyrone is crying. Paint is splashed all over his picture. You must tell him that you’re sorry.”

Although Erin may have participated in a brief “time out”, if she is forced to say she’s “sorry” without understanding why or how it relates to Tyrone’s feelings, she may have difficulty learning empathic behavior. Apologizing just so she can return to an activity might teach her that others’ feelings don’t really matter. Instead, the teacher may need to encourage Erin’s participation in the process by asking:

“How do you think Tyrone is feeling? What might you do to help him?”

Teaching Children to meaningfully apologizeTry the following 3 step process to help your children get started with a meaningful apology.  Ask them to:

  1. Say “I’m sorry for…..(be specific about the behavior)”
  2. Describe how it impacted their friend (or neighbor, etc.)
  3. Tell how they will behave differently in the future

Grampa and the Golden Rule

The other day I was babysitting my 4 year old granddaughter, the one who is the most strong willed and oppositional of all 5 of my grandchildren.  I intervened several times during the day with brief “time outs” because she was not following the house rules or because she was having trouble sharing with her sister and cousins.  After the “time outs” in the morning, we talked about what Jesus would say about the golden rule and about treating others.  After the “time outs” that occurred later in the day, the processing became relatively brief.  “I know Grampy, I didn’t follow the Golden Rule!”  I’m still smiling as I think about her growing realization that Grampy thought this was such a big deal!

Works Cited

W.C. Crain. (1985). Theories of Development. Prentice-Hall. pp. 118-136. By Carla Poole, Susan A. Miller, EdD, and Ellen Booth Church

How to nurture this important gateway to a social and emotional growth
Grades: Early Childhood, PreK–K

Matthew 7:12 English Standard Version (ESV)

The Life Space Interview (LSI) – Behavior Advisor
http://www.behavioradvisor.com/LSI.html

photo credit: sokabs via photopin cc

 

Jeff Ashby PhotoJeff Ashby is a School Psychologist at CLC Network where he integrates his  intensive training in the fundamentals of cognitive behavioral psychology with his Christian faith.  He endeavors to help parents and professionals develop compassion in their understanding of the many challenges that students with special needs face throughout their lives. 

Creating a Community Where Everyone Belongs and Serves

A mother and her adult son were worshiping at a church. They were a hesitant about attending worship because they had been asked to leave a previous congregation. The son’s behaviors were not always in line with what people expected. The son, who has Autism Spectrum Disorder, was having a difficult morning at their new congregation and cried out loudly a number of times.

Eventually, the pastor stopped preaching and asked them if they were okay. Then he prayed for them, and the son found peace; worship continued.

The congregation said, "You are welcome here."The pastor behaved kindly, but how would congregation members react? Would they tell the mother she needed to keep better control of her son? Would they suggest they find another church? Praise God, the members of this congregation gathered around mother and son after the worship service and reassured them kindly.

“You are welcome here.” “Don’t let this keep you from returning.”

This welcome was so different from the way they were treated in previous congregations that they chose to stay. In fact, recently, the son was baptized, and the mother made a public profession of faith. They had found a church home.

Interdependent Community 

Through the apostle Paul, God paints a vision for his people in 1 Corinthians 12 as one body, together in Christ. No one excludes another. (The eye cannot say to the hand, “I don’t need you!”) No one self-excludes. (Now if the foot should say, “Because I am not a hand, I do not belong to the body,” it would not for that reason stop being part of the body.) In fact, the members of the body that seem to be weaker are indispensable to the healthy functioning of the body (1 Cor. 12:22).

Surely, being asked to leave a previous congregation was painful for this mother and son. The church that asked them to leave hurt itself even more than it hurt this man and his mother. Churches that exclude people with disabilities have lost indispensable parts.

Everybody Belongs. Everybody Serves. 

Christian Reformed Church (CRC) Disability Concerns helps churches become healthier communities by learning to follow the biblical model for community in which everybody belongs and everybody serves. This mission pushes against centuries of history and against deep-seated and often unexamined prejudice against people who live with visible and “invisible” disabilities that may be physical, visual, auditory, intellectual, and/or emotional.

I pray that someday people in churches will so embrace God’s vision for biblical community that this vision will be part of the culture of each congregation. Each congregation will clearly portray the guests assembled at the great banquet of Luke 14:15-24. People with and without disabilities will be able to get in and take part; and those with disabilities will join in numbers even greater than their proportion in the larger society. Each congregation will meet or exceed the guidelines and standards of accessibility and participation required by law in the rest of society.  They will accept full responsibility for doing their part in meeting the spiritual and physical needs of the people and families with disabilities in their communities.

Celebrate Disability Week this October

CRC - RCA Disability ConcernsUntil that beautiful time, both CRC Disability Concerns, and our sister organization, Reformed Church in American (RCA) Disability Concerns, encourage congregations to set aside the second or third Sunday in October to think especially about working to become communities in which all people, especially people with disabilities, belong, participate, and serve.

What is your church doing to fully engage everyone? Are you setting aside a special Sunday for this purpose? Find resources — including sermon ideas, litanies, devotionals, and videos — to celebrate Disability Week on the CRC Disability Concerns website and Network site and share with us how your church celebrates disability Sunday/week in the comment section below.

Nicole and Mark StephensonRev. Mark Stephenson serves Christian Reformed Churches as the Director of Disability Concerns. Previously, Mark served as pastor of two churches for 17 years. He and his wife Bev have five children including Nicole, who has severe multiple disabilities. He frequently blogs on the Network.

Graduation Among Friends

Kloosterman family

Jonathan enjoyed celebrating his graduation surrounded by family and friends.

“If you had told me 20 years ago that my son would graduate from high school, I wouldn’t have believed it,” Bob Kloosterman shakes his head in amazement.  His son, Jonathan, graduated from South Christian High School (Grand Rapids, MI) this past spring.

“When we enrolled Jonathan at Dutton Christian School (Caledonia, MI) all those years ago, we didn’t know what to expect.  It was all so new,” he recalls.

“But we saw almost immediately that we didn’t have to worry.  Someone was going to watch out for him.  And his teachers have done a really wonderful job.”

For most students with disabilities, graduation is a very big deal.  And for someone as social as Jonathan, it was extra meaningful to walk across the stage with his classmates.  South Christian offers a certificate of completion, which serves to verify that students have completed goals within an alternative track of study throughout high school.

“I really liked walking down the aisle at graduation with my friends and getting my diploma,” shares Jonathan.  “But I was a little nervous.”

“He was nervous about the graduation ceremony, but the person before or after him helped make sure it went smoothly.  That’s the kind of thing that’s really special to me,” admits Bob.

“When I was that age, my generation was not always so accepting and nice to kids with disabilities.  But I can’t remember anything negative from his entire school experience.”

Congratulations to Jonathan and his peers on their graduation and best wishes on their next steps in life!

Elizabeth Dombrowski photoElizabeth Lucas Dombrowski is the advancement director at CLC Network. 

Building the Kingdom at Sussex Christian School

We are thrilled to share this story from Trish King, principal at Sussex Christian School (Sussex, NJ), on the impact of inclusion on their community.

Photo of Charlote and Corey

Charlote and her friend Corey work on an assignment. You can see why everyone loves her smile!

Meet my friend, Charlote, a third-grade student at Sussex Christian School (SCS). Charlote was adopted from an orphanage in China when she was six years old.

We were so excited to welcome Charlote into our school as a kindergarten student in 2010.  Charlote smiled all of the time and immediately became the most popular student in the school; all the students wanted to spend recess with her.

Both teachers and students could tell that she was eager to learn, but it was difficult to tell what she knew, since she could only speak her native language, Mandarin.  Despite these difficulties, her teacher and class embraced her and it was good. 

But as the kindergartners progressed, Charlote didn’t.  She was learning, but at a slower rate than her classmates.  It was hard to tell if she had a disability or if it was a language barrier.  After much prayer and persistence we were able to test her and found that there was more to her learning difficulty than a language barrier.

Charlote, Corey, and school staff smile for a photo.

We’re so glad to now have the academic support resources to welcome ALL of God’s kids at our school.

Because we could not provide the services Charlote needed to learn and succeed at Sussex Christian, Charlote needed to transfer to a public school.  We would miss her presence–especially her smile–at our school. This move forced us to revisit our commitment to including ALL of God’s children. That year, we decided to partner with CLC Network to help us welcome and support students like Charlote at SCS.

We were so thrilled when Charlote returned to our school at SCS last year!  We welcomed her into our second grade classroom, with academic support provided by our inclusion teacher, Mrs. MacMillien.  Though she had progressed at her former school, she was not reading yet. This time, we were equipped with the resources to support her.

Last June, I stopped in the second grade class where I found Charlote and a friend staying inside during recess.  The two had been making Father’s Day cards.

Though Charlote had struggled with reading, she walked over to a desk and immediately started reading everything that was on the Father’s Day card.

She didn’t know it, but I had tears running down my cheeks.  She was reading!  Praise God for the amazing things that are happening here!

Though inclusion isn’t always easy, we lean on this promise from the Psalms: “Commit your way to the Lord, Trust also in Him and he will bring it to pass” (Psalm 37:6 NKJV). We prayerfully trust that as we commit to welcoming ALL of God’s kids, that he will continue to provide the support and resources, like our partnership with CLC Network, that make this possible.

Learn about the growth of another SCS student in this blog post.

Trish King photoTrish King has been an administrator at Sussex Christian School for eleven years. She is a graduate of Westminster College (New Willmington, PA) and Baptist Bible College (Clark Summit, PA).